Provider Demographics
NPI:1699941955
Name:PHILLIPS, EMILIE (LCSW)
Entity type:Individual
Prefix:
First Name:EMILIE
Middle Name:
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12800 W CREEK PKWY
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23238-1116
Mailing Address - Country:US
Mailing Address - Phone:804-784-6438
Mailing Address - Fax:804-784-5331
Practice Address - Street 1:12800 W CREEK PKWY
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23238-1116
Practice Address - Country:US
Practice Address - Phone:804-784-6438
Practice Address - Fax:804-784-5331
Is Sole Proprietor?:No
Enumeration Date:2008-05-06
Last Update Date:2012-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040080341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical